What Illegal Abortion Looks Like

Many are linking to this story around the blogosphere and I encourage everyone to read it. In it, a Ob/Gyn describes her emergency care of a woman who arrived in her ED in hemorrhagic shock from a botched illegal abortion. Though clearly it was touch and go and there was some panicky action, our heroine thought fast and saved a life. My mother once worked in a labor and delivery ward to put herself through medschool in the days before Roe v Wade and this type of situation was common.

This is a great story because it illustrates two points. One, the war on abortion by the right wing is futile. We know abortion is more common where it is illegal and cases like these are more common. Banning abortion does not save lives. It results in more abortions, and more lives lost. Worse, in countries with strict bans even treatment of ectopic pregnancy is forbidden where there is still a beating heart detected by ultrasound. Doctors in these countries can literally go to jail for saving a woman’s life, all for the sake of a non-viable embryo that will kill the mother. The hypocrisy of calling this position pro-life is demonstrated by cold hard data. More women die. More fetuses are aborted.

Second, it shows how a well-trained doctor can save a life with some quick thinking. Hemorrhagic shock is something I’m pretty familiar with after my second year rotation in Shock Trauma, and in a few spectacular cases of bleeding on the wards. There are many times when as a doctor you think you’ve probably saved a life. Every case of appendicitis, dropped lung, or kid with a gastroschisis technically is a save but situations like those don’t have quite the same visceral terror and immediacy of someone who is bleeding to death right in front of you. It’s hard to keep a cool head when you’re elbow deep in a pool of blood. One case in particular that sticks out in my mind was during a nice calm Saturday in the fall. I had just finished assisting in an open appendectomy and was doing my usual neurotic repetitive rounds through the ICU I always did when I was on call. At this particular hospital, when on call I was responsible for all ED surgical consults, all the surgical floor patients, as well as the surgical ICU (I had to carry 4 pagers). So since I’d been in this case for the last hour or so I decided to check in with the ICU folks. It wasn’t the sickest ICU I’ve ever worked, nothing like the U Maryland Surgical ICU or Cardiac Surgery ICU, but, like the ocean, it’s never a good idea to turn your back on the ICU patients. So, I was passing by one patient’s room and I seen on the monitor a blood pressure of 60/40…

I was lucky, I just happened to be passing by right when this guy’s pressure dropped, before the nurses even had time to page me.

Here’s some history. He was in his 60-70s, a vascular patient with diabetes, hypertension, dyslipidemia, the usual set of comorbidities you see in people after decades of cigarette smoking and high blood sugars. He was in the hospital because he had received a vein graft in his leg a month before but he had unfortunately gotten a surgical site infection. The graft, which was meant to bypass a blocked artery in his leg so he wouldn’t lose his foot or need a below-knee amputation, was still open and working. He had been admitted in septic shock, had acute kidney injury from the shock, and required resuscitation and placement of a large catheter in his subclavian vein so we could perform dialysis. This, sadly, is not particularly uncommon with this patient population. Diabetics and smokers are terrible at healing wounds, and are very prone to infection. His had run rampant, and he had a resistant psuedomonas strain isolated from his blood (also common in diabetics) which was ominous indeed. After stabilization and debridement of his wound he was relatively stable, hanging out in the ICU, and about to be transferred to the floor.

Now, I’m looking at a pressure of 60/40, he’s currently hooked up to the dialysis machine and the nurse has already stopped dialysis and bolused him 500cc of normal saline (wimpy I know, but they’re more timid with dialysis patients). I ask, “what’s going on here?” and the dialysis nurse just says he suddenly dropped his pressure, no idea why. This is not an uncommon event on dialysis but usually the hypotension dialysis patients get isn’t so severe.

So, what do you do in a patient like this? In medicine we usually apply what we call the “ABC’s”. Airway, Breathing, Circulation, followed by a rapid exam. The patient was alert and talking (amazingly), and said he thinks he wet the bed. He was oxygenating ok with a O2 sat in the 90s so that takes care of A and B. For circulation we started bolusing IV fluids through his quinton catheter as fast as we could squeeze them in. This took all of 5 seconds with a good ICU nurse at the bedside. Then the nurse pulled the sheet off the patient so we could get a look at him and we saw the problem. He was sitting in a pool of blood an inch deep. It was probably between 30-50% of his blood supply in the bed, and from his surgical incision, just alongside his knee blood was pumping out in arterial spurts. The infection had compromised the integrity of the graft, and now we had catastrophic bleeding.

No time to lose I grabbed his knee in a death-grip, holding the exploded vein graft shut with two fingers. A lot of people in the face of massive bleeding make the mistake of piling gauze on a bleed. This does nothing to achieve hemostasis. Direct digital pressure to a bleeding site is the way to go.

Another piece of luck, the anesthesiologist and my chief resident were still in the building because of the appy. A few quick pages and a stat blood order later we were off to the OR with me riding on the bed so I could fit through the doors without having to let go of his leg.

Ultimately he lived, his kidneys recovered and he went home.

Hemorrhagic shock is one of those situations where the adrenaline flows but if you remember your training and follow some basic rules of resuscitation it’s highly amenable to treatment. We can always put blood back in, but you have to find the bleeding and arrest it quickly to save the life. Dr. Gunter knew this, and her expertise allowed her to save the life of an unfortunate young woman that would have never been in that position if contraceptives were easily available and if her abortion had been safe and legal. If we are honestly concerned about the preservation of life, we must divorce ourselves from emotion over this issue and accept the data that clearly shows restricting abortion does not prevent it, only increased access to contraception will lower abortion rates.

Comments

  1. #1 Tsu Dho Nimh
    February 13, 2012

    I will add … to make that “stat blood order” you have to have plenty of blood already in the blood bank, typed, screened for unwanted antibodies, checked for communicable diseases, and ready to go. That doesn’t happen by magic.

    GO DONATE BLOOD! Because if you wait to donate until you hear the news that your neighbor blew a vein graft, or was in a serious car crash, or had a problem delivery, you’ll be going to funerals.

  2. #2 Ms. Justin Smith
    February 13, 2012

    Abortion was back alley slice and dice before Roe vs.Wade. Or women got a coat hanger, metal, and did it themselves. Puncturing an organ was not unusual.
    All of this uproar is about trying to take women back to the time when Pregnancy was looked at as a “Punishment” for the Sin of sex outside of marriage. If the woman has an abortion then she escapes that stigma (that used to be). If a woman has contraception then she will “Sin” and have sex outside of marriage. If she dies then that is OK because that is what she deserves for sinning against God.
    This is all about Religion, deny it though they may. “Are you Saved or are you Damned?” Have sex outside of marriage and you deserve what you get.
    How filled with Hate these people are!.

  3. #3 mk
    February 13, 2012

    Your story reminds me of the Clint Mularchuk (sp?) event. Hockey goalie sliced in the neck by a skate, spewing blood (youtube if you wish) and the team “doctor” was a former vietnam medic (if memory serves), he reached into the goalie’s neck and pinched the artery until help arrived. Scary stuff.

    I think I’ll go donate some blood now.

  4. #4 parkay
    February 13, 2012

    Abolition now.

  5. #5 D. C. Sessions
    February 13, 2012

    Banning abortion does not save lives. It results in more abortions, and more lives lost.

    Yeah, but the bitches deserved it.

  6. #6 Calli Arcale
    February 14, 2012

    That was a gut-wrenching article, and it was interesting reading through the comments. It is interesting how even today, so many people think it’s an easy thing for a woman to have a baby, and cannot understand why she might not want to do it. I suppose I should be glad so many people have stable lives, since that’s the only explanation for why they don’t understand.

    Banning abortion would solve nothing. We need to lower the abortion rate, but not by banning abortion; I see the abortion rate as a symptom, not the actual disease. We need to reduce pregnancy rate in the first place — and that means destigmatizing rape, empowering women (yeah, rich women have equality, most of the time, but poor women absolutely do not), and providing a real, solid support structure for families. And not just one that’s about lecturing those who aren’t the right sort of family; if you’re “the right sort” obviously you don’t need additional support anyway. (And so many who want to restrict government aid to the “right” people are Christians. I don’t get that. Jesus didn’t come to minister to the most saintly of people, but to the lost, the desperate, the abandoned . . . in short, the ones who needed the most help.) Education is a huge part of this; abstinence-only sex ed is ridiculous. We need sex ed that teaches kids to have healthy sexuality; that goes beyond contraception, because a big part of the problem in my opinion is that kids don’t understand what to expect out of sex and romantic relationships and don’t easily recognize when it’s going wrong. Education from an early age, before they start dating, might help more girls get out of abusive relationships and not lose the ability to negotiate safe sex and/or abstinence. They also need to be able to recognize when they’re pregnant as early as possible. I know what the conservatives will say — that’s for the parents to be teaching. And ideally, I’d agree, except that obviously a very large percentage of parents are either shirking that entirely or doing a very crappy job of it. For the sake of our society, the public school system needs to step in.

    And we need cheap and accessible contraception, along with the destigmatizing of it. In another thread, I commented how I was bullied in junior high, and on one occasion, had a condom thrown on me. There is still some sentiment in our society that condoms are degrading, and that is definitely part of the problem as well. I’d consider finding a way to make free pregnancy tests available discreetly, so that girls can check as early as possible (with some way to make sure they know the test can’t turn a positive for at least two weeks after intercourse; the pregnancy has to become fully established for there to be enough hormone in the mother’s urine for the test to detect), and I’m hugely in favor of making emergency contraception freely and discreetly available as well, as well as the more proactive forms of contraception.

    Hemmorhagic shock sounds terrifying. It’s not just a risk of illegal abortions; it’s part of the reason I am disturbed by the growing trend in unattended home birth. It can happen in deliveries as well. A few years ago, there was an ad promoting blood donation, and one of the cases they flashed on the screen was a woman who required something like 150 units of blood when her son was born via emergency c-section after her uterus ruptured. She had agreed for her story to be used to help people understand the need for blood.

    Give blood. Now!

  7. #7 Gwenfrewi
    February 14, 2012

    Ideally, abortion should be unsought, unwanted and unnecessary, rather than legal.

  8. #8 Are You Kidding
    February 14, 2012

    GO DONATE BLOOD!

    I would love to but the archaic and outdated rules that allow a straight guy to donate blood after having sex with an untold number of women prevents me, as a gay person, from ever donating blood for any reason, ever, no exceptions.

    That is unless I lie and I won’t do that. :-(

  9. #9 Calli Arcale
    February 15, 2012

    Yeah, that is definitely a problem with the blood donation system. :-(

  10. #10 law talking girl
    February 15, 2012

    Those same archaic and outdated rules prevented me from donating blood last weekend because I, a straight woman, had sex within the last year with a man who had been raped as a child, approximately 25-30 years ago. The rules also presumably prevent that man from ever donating blood.

  11. #11 Calli Arcale
    February 16, 2012

    They should, at the very minimum, put some sort of window on it. Any STDs would surely have shown up long ago in your partner’s case, law talking girl. And Are You Kidding, I can’t help but think they should have a better way of fine-tuning the risks and only eliminating those with a substantial risk.

    Until recently, my husband was also barred, because his mother had hepatitis while pregnant with him. The rules have changed now, and as long as the child never showed symptoms, it’s okay. Surely they can fine-tune other things. I know some other people who used to be deferred for various conditions but are now accepted; surely they can fine-tune these rules as well.

    But this is all the more reason why people like me, who have no reason to be deferred, need to give blood as often as possible. So many of those who want to give are not eligible, and so many of those who are eligible are not willing. Those few who are both willing and eligible are in constant demand.